On Nozick, On Williams

Bernard Williams and Robert Nozick are two philosophers I really enjoy reading. Seeing one directly address the other in print is strangely amusing, like finding out that two good friends you had met at different places and times in your life actually know each other (I had assumed, I suppose, that although Williams and Nozick were contemporaries, and certainly knew of each other’s work, they worked in different areas and thus probably never ‘squared off’ over any particular issue). That’s Williams on the left, and Nozick on the right. Pretty dashing–and downright Adonises by philosophical standards.

So let’s hear from Williams first. In a well-known essay titled “The Idea of Equality,” published in 1962, Williams writes:

Leaving aside preventive medicine, the proper ground of distribution of medical care is ill health: this is a necessary truth. Now in very many societies, while ill health may work as a necessary condition of receiving treatment, it does not work as a sufficient condition, since such treatment costs money, and not all who are ill have the money; hence the possession of sufficient money becomes in fact an additional necessary condition of actually receiving treatment….When we have a situation in which…wealth is a further necessary condition of the receipt of medical treatment, we can once more apply the notions of equality and inequality…since we have straightforwardly the situation of those whose needs are the same not receiving the same treatment, though the needs are the ground of the treatment [my emphasis]. This is an irrational state of affairs…it is a situation in which reasons are insufficiently operative; it is a situation insufficiently controlled by reasons–and hence by reason itself.

Now, here’s Nozick, responding to this passage in a section of his well-known book Anarchy, State, and Utopia:

Williams seems to be arguing that if among the different descriptions applying to an activity, there is one that contains an “internal goal” of the activity, then (it is a necessary truth that) the only proper grounds for the performance of the activity, or its allocation if it is scarce, are connected with the effective achievement of the internal goal. If the activity is done upon others, the only proper criterion for distributing the activity is their need for it, if any….But why must the internal goal of the activity take precedence over, for example, the person’s particular purpose in performing the activity?….[Is it the case that] the only proper criterion for the distribution of barbering services is barbering need[?]….Need a gardner allocate his services to those laws which need him most?

What we arrive at is the claim that society (that is, each of us acting together in some organized fashion) should make provision for the important needs of all of its members. This claim, of course, has been stated many times before. Despite appearances, Williams presents no argument for it. Like other, Williams looks only to questions of allocation. He ignores the question of where the things or actions to be allocated and distributed come from.

This seems to me a pretty shoddy criticism of the argument Williams puts forth in the passage I cited above–certainly beneath Nozick’s standards, which, I think, are generally quite high. For starters, anybody who reads the passage from Williams in the context of Williams essay–which, of course, is how it should be read–will know exactly how Williams would answer Nozick’s rhetorical question concerning why the ‘internal goal’ of an activity should take precedence over other considerations when determining who should become practitioners of the activity in question and how the scarce goods/services produced by/associated with the activity should be allocated. Williams is arguing the broader point that giving precedence to the internal goal of the activity is a way to distribute opportunity and resources unequally in a way that does not violate a political society’s commitment to equal treatment and equal respect for all citizens. It’s a way of giving any and all citizens a reason for an unequal distribution that they should each be able to accept as relevant–roughly,an unequal distribution is called for insofar as it is the most effective way of achieving/realizing the internal aims of the practice. More roughly still, the unequal distribution ‘follows,’ as it were, from the raison d’etre of the practice: nobody should complain that it’s unfair that only the sick get medical care, but in a political society that pays lip-service to egalitarian principles one could with full justification complain if only the sick and relatively wealthy get medical care, for ‘wealth’ is manifestly irrelevant to the central purpose or ‘internal aim’ of the practice of health care.

Also, as Nozick himself seems to sense, the comparisons to barbering and gardening are totally specious. Nozick seems to be implying that society cannot legitimately tell providers of some good/service, G, the basis on which they may provide G. Just how radical this claim is might be missed when we’re focusing on barbers and gardeners (even in these cases, though, we do not allow barbers to distribute barbering services on the basis of race).

But its radicality isn’t its main defect–rather, it just seems so uncompelling (I’m afraid maybe I’ve begun to internalize some lessons that Josh has been trying to teach me on this blog. Perish the thought!) We do not have natural rights to become doctors, barbers, gardeners, or whatever–these options are available to us because we are members of a system of social cooperation (a political society), and in this case membership has its costs as well as its privileges. We don’t get to barber, for example, however the hell we want to barber and with whomever the hell we want to barber. Along with making it possible for one to earn a living as a barber, our society lays down some guidelines and laws. Any individual unwilling to follow these guidelines and laws should not become a barber. Mutatis mutandis for doctoring. There’s just no compelling complaint against those who would say that as a doctor in our society, you will have to provide medical care to people independently of their ability to pay. If you don’t want to do that, don’t become a doctor–become, I don’t know, a barber, where allocating services on the basis of ability to pay is allowed and even enforced by the law!

One way to see that Williams is on higher ground here, I think, is to imagine the disagreement being about legal defense services instead of health care. What is the internal aim of our punishment practice? That’s not obvious, I know, but it seems plausible to conceive of our punishment practice as related to guilt in something like the way health care is related to illness. In each case, the social institution arises in direct response to a clearly identifiable problem–people get sick, and people break the laws. Society should have a plan for dealing with these inevitabilities. Now notice that in our society–the one we actually live in, hardly an egalitarian paradise, we do not treat ability to pay as a necessary condition for obtaining a legal defense. If you cannot afford an attorney, one will be provided to you. Why do we do this? Per Williams’s argument, we could say that we do this because we recognize that the amount of money a person has is clearly irrelevant to questions concerning his guilt or innocence, which questions explain why we have a social practice called ‘lawyering’ in the first place, and so considerations of wealth should not factor into whether or not one is able to get a lawyer.

I’ll close with a question I’ve been mulling over recently: why is Universal Health Coverage supposedly ‘controversial,’ while ‘Universal Legal Coverage’ is not?

7 Responses to On Nozick, On Williams

I’ve barely read anything Williams wrote (unless forced to in a class, but I’ve long sense forgotten). Where would be a good starting point?

The argument you’ve described Williams as making strikes me as similar to a line of argument Michael Walzer makes in his _Spheres of Justice_: that we can judge the way that distribution of a good ought to be regulated by the nature of the good (which sounds like what Williams calls the “internal aims of the practice.”

One flip, more Marxist sort of thing to say here (which I’ll go ahead and say) is capitalist structures have a tendency to move us away from things like “internal aims” and towards the exchange-value of a service, in the extreme case, making us lose sight almost entirely of the internal aim, to the point where we start to think someone must be a “bleeding heart liberal” etc. if they don’t immediately grant the supremacy of the doctor’s/lawyer’s/etc. desire for wealth vis-a-vis any humanitarian counter-claims. Marx glosses the Bible’s “the want of money is the root of all evil” as describing this very process. The collection of money has no internal/external distinction (except in the case of compulsive money hoarding, a la King Midas or Silas Marner). A society which respects wealth-accumulation so greatly is bound to see its logic trump the logic of other more traditional spheres of human life.

Your question about health coverage/legal coverage is a good one.

Let’s say something like Williams’ argument works. If that’s the case, there’s no good reason to distinguish between the two, but the phenomenon remains: people have a deeply respected right to counsel (even if cops on cop shows seem to resent it), but government provision for health care is not nearly as deeply respected. In many parts of the country right now, in fact, it’s deeply feared and loathed (even though those same people “want the government to keep its hands off their medicare”).

I’ve got a couple of flip answers to explain the phenomenon and then one more serious one.

Flip answer #1 – lawyers see the value of their work; they’re the ones that make court decisions and write statutes; they’ve written it in many times over; people have acquiesced in that. Were a whole branch of government made up entirely of doctors, the same might happen with medical care. But it is not, so it hasn’t.

Flip answer #2 (related to #1) – the 5th and 6th amendment (or some combination?) in the United States explicitly protect the right to counsel. There is no analogous right to health care enumerated in the constitution. People have tried to force the 14th amendment to play this role, but courts have never seen it that way. Such a decision would be the sort of positive-rights version of Lochner v. New York (which tried to derive a substantive right to property from that same amendment, one that would have become actionable against things like minimum wage laws and other workplace regulations; I believe this is one of the decisions FDR’s court-packing maneuvers were in retaliation against).

Less Flip Answer #3 – in the United States anyway, access to health care (and therefore good health) is seen as something wealthy people deserve more than their poor fellow citizens. This may be because of its historical ties to employers (in ww2 health care coverage was tied to the workplace in an end-run around wage caps) – so if you don’t have a job, you don’t deserve medical care. And that may have something to do the protestant work ethic. “The rich stay healthy; the sick stay poor” is a U2 aphorism, but it seems to be something a lot of people in the United States somehow think is how it should be.

Related answer – though we philosophers know that any version of the negative rights/positive rights distinction is really hard to sustain (and along with it, the harm principle), the general public believes very strongly in these distinctions. Again, I think libertarianism is a highly unstable theoretical position, but many people seem very comfortable with that instability, even to the point of seeing it as a strength – hence the popularity of “I’m fiscally conservative but socially liberal.”

Williams has written so much great stuff, on so many different philosophical topics, that it’s hard to know what to suggest as a diving in point. But….I’m leaning toward his book Shame and Necessity, which I think you’ll love given your general interest in Homer and the Greeks (or is that Nates?). Anyway, it’s a really cool book, where Williams basically argues that if what passes for ‘Greek moral psychology’ seems bizarre to us it is only because Kant & others have turned our culture’s attention away from a psychologically deep and realistic investigation of moral life as we actually live it. You should read it.

The connection between Williams and Walzer is interesting–I only know Walzer through his book, Just and Unjust Wars. I take it you’d recommend his book on justice?

Your explanations of the peculiar kind of theoretically isolated opposition to universal health care strike me as reasonable–I’m guessing there’s not a principled, theoretically satisfying account out there that I’m missing (But who knows? I haven’t really done my homework). It’s interesting though that the opposition can’t even trot out the problematic but, at least, familiar distinction between negative and positive rights, as I’m pretty sure a right to legal counsel fall within the class of ‘positive rights.’ But then I’m just left scratching my head, for how can anyone think that having access to HEALTH CARE isn’t as crucially important to each and every citizen’s well-being as just about any other need our society might provide for? Perhaps there’s an implicit distinction at work here between what citizens deserve or are owed–a fair hearing, the chance to face their accusers, etc., etc.–and what citizens need, however desperately or badly. But I’m just speculating, and I’m obvious very skeptical about whether this distinction could do enough work to make sense of current hostilities towards the idea of UHC in this country.

Here’s a speculative, historical explanation for the difference. In the Early Modern / Enlightenment era, when American political culture was being decisively shaped, the quality of healthcare just wasn’t very good. Access to a doctor wasn’t likely to make a huge difference in your life–in some cases it might make things worse! By contrast, the legal profession was in a more advanced state. In this context, it would make sense that people were more worried about ensuring legal access for all. Maybe we’re just in the midst of the slow cultural process of adjusting to a new state of affairs.

Well, my sense is that one answer to David’s question about “universal legal coverage” is that we don’t have it. Read any news article on the 50th anniversary of Gideon v. Wainwright (the case that required legal representation to be provided by the state in felony cases). It may not be controversial in theory, but it is not applied in practice: public defenders are overworked, underpaid, etc. etc. They give shoddy legal representation because they have no time, no resources.

(Of the cuff, I’d also say: when someone is imprisoned by the state, there is a question of the state’s credibility on the line. Did they get the right guy? Or did the falsely imprison someone? So the state has an incentive to make sure its convictions are credible; hence they supply attorneys and require proof beyond a reasonable doubt, etc.. The state is not similarly on the line when someone is sick. They can escape responsibility — hence, blame — for a person’s illness. So why incur extra cost in providing free healthcare when it won’t make you look any better, and may make you look worse if something goes wrong?)

On the Williams v. Nozick debate, I think there may be more to what Nozick says. The key line is: “Like other [missing word?], Williams looks only to questions of allocation. He ignores the question of where the things or actions to be allocated and distributed come from.”

Doctors don’t grow on trees, the argument seems to be. We have to give people adequate incentives to become doctors and to remain doctors. If we don’t, there will be no doctors, and no doctoring to distribute. This is very clearly a bad state of affairs. So we can’t ignore where doctors come from in deciding how our system of allocation would work. If we force doctors to take all comers at very little pay, we will have fewer and fewer doctors, and less health care for everybody. People will become barbers instead.

It might be better to have a system where doctors are paid a little more, and have their choice of whom to serve. Then we can tax them, and use that money to pay for health care for the poor. This strikes me as something of a Rawlsian solution, which accommodates both Williams and Nozick.

That’s really interesting, Chad. I hadn’t thought about how the State might have an “incentive to make sure its convictions are credible.” Of course, this point seems to cut against your first, which is that the State doesn’t provide adequate legal coverage for the poor. If the State were actually concerned with upholding the credibility of its convictions, why would it pay mere lip service to providing the poor with an adequate legal defense?

Anyway–you’ve identified an important difference between legal guilt and poor health–the State is ‘in a sense’ responsible for the former but not the latter–one that I missed in pressing my point about why some might oppose universal health care but not universal legal coverage.

The state is, I suppose “analytically” responsible for regulating legal guilt. We’d need a more “synthetic” argument that establishes that it’s responsible for poor health. Obviously a host of such arguments exist but they don’t fall out of the definition of “state.” [yes, I know the analytic-synthetic distinction is naive and problematic]